Clinical Prior Authorization & Appeals Specialist

Pantherx Specialty LLC; Pittsburgh (Allegheny County); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Hybrid/Remote work options

Health benefits

401K with employer matching

Life insurance & disability coverage

Employee Assistance Program (EAP)

Generous paid time off and holidays

Job summary

PANTHERx Rare Pharmacy in Pittsburgh, PA is seeking a Clinical Authorization and Appeals Specialist to provide support and education to health care providers for prescribed therapies. This role serves as the primary contact for coordinating documentation with prior authorization and appeals criteria.

The position requires an RN with 1–3 years direct patient care, strong writing skills, and proficiency in MS Office.

Qualifications

• RN license (RN) required with 1–3 years direct patient care experience.
• Strong writing and grammar skills are essential.
• Strong organizational skills and computer proficiency (MS Office/Windows) required.

Responsibilities

• Educate providers on prior authorization and appeals criteria.
• Assess clinical documentation for alignment with plan criteria.
• Develop initiatives to improve patient adherence and care.

Skills

Registered Nurse (RN)

Strong writing skills

Strong organizational skills

Independent work capability

Education

Associate or Bachelor’s degree in nursing

Tools

MS Office

Job description

PANTHERx Rare Pharmacy in Pittsburgh, PA is seeking a Clinical Authorization and Appeals Specialist to provide support and education to health care providers for prescribed therapies. This role serves as the primary contact for coordinating documentation with prior authorization and appeals criteria.

The position requires an RN with 1–3 years direct patient care, strong writing skills, and proficiency in MS Office.